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中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (10) : 740 -745. doi: 10.3877/cma.j.issn.1674-0785.2019.10.005

所属专题: 乳腺疾病 文献

临床研究

对比增强乳腺X线摄影强化特点及其诊断浸润性乳腺癌的价值
锁彤1, 公维云2, 孟潘庆3, 谢元忠2, 李秀娟2, 盛蕾2,()   
  1. 1. 271000 山东省泰安市中心医院医学影像科;271000 山东省泰安市中心医院肿瘤外科
    2. 271000 山东省泰安市中心医院医学影像科
    3. 271000 山东泰安,山东第一医科大学影像医学与核医学
  • 收稿日期:2019-03-06 出版日期:2019-05-15
  • 通信作者: 盛蕾
  • 基金资助:
    山东省自然科学基金面上项目(ZR2017MH063)

Value of contrast-enhanced spectral mammography features in diagnosis of invasive breast carcinoma

Tong Suo1, Weiyun Gong2, Panqing Meng3, Yuanzhong Xie2, Xiujuan Li2, Lei Sheng2,()   

  1. 1. Department of Clinical Imaging, Tai′an Central Hospital, Tai′an 271000, China;Shandong Academy of Medical Sciences, Shandong First Medical University, Tai′an 271000, China
    2. Shandong Academy of Medical Sciences, Shandong First Medical University, Tai′an 271000, China
    3. Department of Oncology, Tai′an Central Hospital, Tai′an 271000, China
  • Received:2019-03-06 Published:2019-05-15
  • Corresponding author: Lei Sheng
  • About author:
    Corresponding author: Sheng Lei, Email:
引用本文:

锁彤, 公维云, 孟潘庆, 谢元忠, 李秀娟, 盛蕾. 对比增强乳腺X线摄影强化特点及其诊断浸润性乳腺癌的价值[J/OL]. 中华临床医师杂志(电子版), 2019, 13(10): 740-745.

Tong Suo, Weiyun Gong, Panqing Meng, Yuanzhong Xie, Xiujuan Li, Lei Sheng. Value of contrast-enhanced spectral mammography features in diagnosis of invasive breast carcinoma[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(10): 740-745.

目的

探讨对比增强乳腺X线摄影术(CESM)的强化特点及其诊断乳腺癌的价值。

方法

回顾性分析2017年月至2019年3月在山东省泰安市中心医院就诊的138例临床怀疑乳腺肿瘤的女性患者资料,并以手术或组织活检的病理结果为参考标准,参照第5版乳腺影像报告及数据系统(BI-RADS)对乳腺肿瘤进行评估分类。统计乳腺浸润癌、原位癌及良性肿瘤的强化程度(轻、中、重度)、强化密度(均匀、不均匀)及强化方式[流入型(Ⅰ型)、平台型(Ⅱ型)、流出型(Ⅲ型)],使用χ2检验比较3者间的差异。

结果

138例患者共147个乳腺肿瘤,其中40个良性肿瘤,86个浸润癌,21个原位癌。96.5%(83/86)的浸润癌、42.9%(9/21)的原位癌、15.0%(6/40)的良性肿瘤表现为中、重度强化(χ2=87.878,P<0.001)。91.9%(79/86)的浸润癌、85.7%(18/21)的原位癌、73.5%(25/34)的良性肿瘤表现为不均匀强化(包括环形强化)(χ2=7.036,P=0.030)。90.7%(78/86)的浸润癌、47.6%(10/21)的原位癌、32.4%(11/34)的良性肿瘤表现出Ⅱ型、Ⅲ型强化方式(χ2=45.683,P<0.001)。中、重度强化诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为96.5%(83/86)、42.9%(9/21)、17.6%(6/34);不均匀强化诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为91.9%(79/86)、85.7%(18/21)、73.5%(25/34);Ⅱ型或Ⅲ型强化方式对诊断乳腺浸润癌、原位癌、良性肿瘤的敏感度分别为90.7%(78/86)、47.6%(10/21)、32.4%(11/34)。

结论

CESM上肿块显示为中、重度强化,不均匀强化,流出型(Ⅱ型)、平台型(Ⅲ型)强化方式,对于乳腺浸润癌有较大的诊断价值。

Objective

To assess the diagnostic value of contrast-enhanced spectral mammography (CESM) features in breast carcinoma by analyzing the CESM features of benign and malignant breast tumors.

Methods

A retrospective analysis was performed on 138 female patients with clinically suspected breast tumors in Tai′an Central Hospital from July 2017 to March 2019. The breast tumors were evaluated and classified according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) standard. Based on the pathological results of surgery or biopsy, the degree (mild, moderate, and severe), density (homogeneous and heterogeneous), and pattern of enhancement (typeⅠpersistent, typeⅡplateau, and typeⅢ washout) of different tumors were statistically analyzed. The Chi-square test was applied to analyze the different features between the benign tumors group, carcinoma in situ (DCIS) group, and invasive carcinoma group.

Results

A total of 147 breast tumors were confirmed by pathology, including 40 benign tumors, 86 invasive carcinomas, and 21 DCIS. Approximately 96.5% (83/86) of invasive carcinomas, 42.9% (9/21) of DCIS, and 15.0% (6/40) of benign tumors showed moderate or severe enhancement (χ2=87.878, P<0.001); 91.9% (79/86) of invasive carcinomas, 85.7%(18/21) of DCIS, and 73.5% (25/34) of benign tumors showed heterogeneous enhancement (including ring enhancement) (χ2=7.036, P=0.030); 90.7% (78/86) of invasive carcinomas, 47.6% (10/21) of DCIS, and 32.4% (11/34) of benign tumors showed typeⅡor Ⅲ enhancement (χ2=45.683, P<0.001). The sensitivity of moderate or severe enhancement for the diagnosis of breast invasive cancer, DCIS, and benign tumors was 96.5% (83/86), 42.9% (9/21), and 17.6% (6/34), respectively; the sensitivity of heterogeneous enhancement was 91.9%, 85.7%, and 73.5%, respectively, and the sensitivity of typeⅡorⅢ enhancement was 90.7% (79/86), 47.6% (10/21), and 32.4% (11/34), respectively.

Conclusion

Moderate or severe enhancement, heterogeneous enhancement, and typeⅡor Ⅲ enhancement on CESM are valuable for the diagnosis of invasive breast cancer.

图1~5 患者女,49岁,右侧外上象限乳腺良性肿块 图1、2分别为双侧乳腺头尾位和内外斜位X线摄影,示右侧乳腺外上象限分叶状肿块影(箭),诊断为BI-RADS 4A类;图3、4分别为双侧乳腺头尾位及内外斜位对比增强X线摄影示未见异常强化肿块影,修改诊断为BI-RADS 3类;图5为纤维囊性乳腺病病理图(HE染色,×20)
图6~9 患者女,45岁,左侧多灶乳腺癌 图6为双侧乳腺头尾位X线摄影示左侧乳腺外象限不对称致密影,内象限未见异常肿块影,诊断为BI-RADS 3类;图7为双侧乳腺头尾位对比增强X线摄影示左侧乳腺外象限较大不规则肿块影(箭),呈中度强化,修改为BI-RADS4C类,左侧乳腺内象限见2处较小的沿导管走行的不规则形轻度强化灶(圈),修改为BI-RADS4A类;图8为左侧乳腺内象限2处较小肿块的手术病理图片,为原位癌(HE染色,×10);图9为左侧乳腺外上象限较大肿块的病理图片,示非特殊型浸润性癌(HE染色,×10)。
图10~14 患者女,54岁,左侧乳腺外上象限乳腺癌 图10、11分别为双侧乳腺头尾位和内外斜位X线摄影,示左侧乳腺外上象限见不对称致密影(箭),诊断为BI-RADS 3类;图12、13分别为双侧乳腺头尾位及内外斜位对比增强X线摄影,示左侧乳腺外上象限见不规则肿块影(箭),呈明显不均匀、流出型强化,左侧腋窝轻度强化肿大淋巴结(△),修改诊断为BI-RADS4C类;图14为肿块手术病理图片,示非特殊型浸润性癌(HE染色,×20)
表1 乳腺浸润癌、原位癌、良性肿瘤的强化特点[例(%)]
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